Abstract
BACKGROUND: There has been a gradual shift from open spine surgery to minimally invasive techniques such as endoscopic spine surgery to reduce approach-related trauma, collateral damage, and complications. While recovery following surgery has been measured using subjective measures including patient-reported outcome measures, the introduction of smart wearable devices now provides both an objective and continuous method of patient assessment. This prospective study compares patient recovery after uniportal endoscopic and open lumbar spine surgery by analyzing mobility and gait metrics captured by a wearable sensor. METHODS: Participants included 24 patients who underwent a single-level uniportal endoscopic lumbar decompression or open posterior lumbar fusion. During the first 48 hours after surgery, patients wore a sensor that continuously monitored position, step count, and gait metrics. RESULTS: In the immediate postoperative period, endoscopic spine surgery patients experienced a quicker return to mobility, with less time lying down, higher step count, faster gait velocity, lower double support percentage, and reduced variability, compared with open spine surgery patients. CONCLUSION: There are key differences in patient mobility and gait following uniportal endoscopic and open spine surgery. Endoscopic spine surgery patients had faster recovery, which can guide resource allocation toward the development of training programs and support the advancement of spine endoscopy to address a broader range of pathologies. This pilot study highlights the potential for wearable devices to be used in further studies to form spine surgery recovery trajectories, allowing targeted rehabilitation and prompt intervention for deviations in patient recovery. CLINICAL RELEVANCE: This study demonstrates the benefits of endoscopic spine surgery for improved postoperative recovery in terms of mobility and gait metrics. Additionally, it highlights the potential for wearable sensor technology to provide an objective and continuous method for assessing postoperative outcomes and for the development of individualized rehabilitation protocols. These findings support the broader adoption of endoscopic techniques and emphasize the value of incorporating wearable devices into postoperative monitoring to optimize patient care.